Individual provider Active NPI

Wagdy Hanna, CSA

  • Surgical Assistant
  • Clearwater, FL
National Provider Identifier
1134450414
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical AssistantTaxonomy code 246ZC0007X
License
3076 Issued in VA
Practice address
29253 US Highway 19 N
Clearwater, FL 33761-2102
Phone
(713) 779-9800
Fax
(713) 779-9862
NPI assigned
Jan 26, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Technologist 246ZS0410X 3076 VA
Surgical Assistant 246ZC0007X 3076 VA Primary

Addresses

Primary practice location

29253 US Highway 19 N
Clearwater, FL 33761-2102

Mailing address

7324 Southwest Fwy Ste 1550
Houston, TX 77074-2053
Phone (832) 804-8702

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3076VAMDSurgical Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Clear Lake Sa Services, Inc. CurrentSince Aug 9, 2020 Accepting new patients

Locations

29253 US Highway 19 N
Clearwater, FL 33761
Phone (713) 779-8900

7324 Southwest Fwy
Ste 1550
Houston, TX 77074
Phone (832) 436-4273

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1134450414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7324 SOUTHWEST FWY STE 1550",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770742053",
            "telephone_number": "832-804-8702",
            "fax_number": "832-804-8702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29253 US HIGHWAY 19 N",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337612102",
            "telephone_number": "713-779-9800",
            "fax_number": "713-779-9862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNA",
        "first_name": "WAGDY",
        "credential": "CSA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-26",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "VA",
            "license": "3076",
            "primary": false
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "VA",
            "license": "3076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.